Project Summary/Abstract: The objective of this proposal is to perform proof-of-concept experiments on a new hand-held surgical instru- ment that provides dexterity at the tip of a rigid bronchoscope. This approach is less invasive than traditional open surgery, and will be safer than the current rigid bronchoscopic approach, which lacks dexterity in port-delivered instruments. Our new system will feature needle-sized manipulators deployed through the bronchoscope's port and will enable lateral tool motion for independent tissue manipulation, laser aiming, and visualization, which we hypothesize will make central airway obstruction surgery more accurate and ef?cient. Clinical signi?cance comes from the many patients affected by central airway obstruction ? over 80,000 per year in the USA alone [5, 7] ? as well as the severity for individual patients, since lack of an adequate airway is fatal. Existing surgical approaches are challenging because instruments deployed through bronchoscope ports lack lateral dexterity, and consequently complication rates are high (32% of patients will have complications including broken teeth, cervical spine injury, hemorrhage, and even death). Innovation comes from using elastic interactions in curved tubes to create needle-size manipulators that can bend and elongate. This enables us to make manipulators small enough to pass through the port in a clinical bronchoscope to provide tentacle-like dexterity at its tip. Our system will also be innovative because it will be the ?rst commercial robotic system designed for central airway surgery, and because it will be a small hand-held tool rather than a large, complicated system in which the surgeon sits at a console remote from the patient and teleoperates a large multi-arm robot that surrounds the patient. Our new hand-held paradigm is advantageous from both a work?ow and cost perspective, because it is compact with dramatically fewer mechanical and elec- tronic components, and so has the potential to be an order of magnitude less expensive than the surgical robots on the market today. Our approach in Aim 1 is to create a hand-held unit that clips onto the back of the bronchoscope and enables the surgeon to control our proposed needle-sized, tentacle-like instruments. Accomplishing this will require hardware adaptations to an existing concentric tube actuation unit prototype developed in an academic laboratory (technology that will be transferred to Virtuoso Surgical via this project), as well as the design and manufacturing of tubes customized for the requirements of central airway obstruction surgery. In Aim 2, we experimentally validate the feasibility of removing central airway obstructions in anthropomorphic phantoms and an ex vivo insuf?ated porcine lung model. The end result of this Phase I STTR project will be experimental validation of the feasibility of resecting central airway tumors with our new hand-held robot paradigm. This will set the stage for the development of a sterilizable, biocompatible product in the context of a follow-on Phase II project.